Hepatic splenosis preoperatively diagnosed as hepatocellular carcinoma in a patient with chronic hepatitis B: a case report

Abstract

We report on a case of hepatic splenosis. A 32-yr-old man underwent a splenectomy due to trauma at the age of 6. He had been diagnosed as being a chronic hepatitis B-virus carrier 16 yr prior to the surgery. The dynamic computer tomography (CT) performed due to elevated serum alpha-fetoprotein (128 ng/mL) demonstrated two hepatic nodules, which were located near the liver capsule. A nodule in Segment IVa had a slight enhancement during both the arterial and portal phases, and another nodule in Segment VI showed a slight enhancement only in the portal phases. Dynamic magnetic resonance imaging (MRI) of the mass in Segment VI showed enhanced development in the arterial phases and slight hyperintensivity to the liver parenchyma in the portal phases. These imaging findings suggested a hypervascular tumor in the liver, which could be either focal nodular hyperplasia, adenoma, or hepatocellular carcinoma (HCC). Even though these lesions were diagnosed as HCC, some of the findings were not compatible with typical HCC. On dynamic CT and MRI, all lesions showed a slight arterial enhancement and did not show early venous washout. All lesions were located near the liver capsule. These findings, along with a history of splenectomy, suggested a diagnosis of hepatic splenosis.

Fig. 1

Arterial phase (A, B) and portal phase (C, D) of abdominal CT scans show a 2-cm mass in Segment IVa and a 3-cm exophytic mass in Segment VI (arrows).

Fig. 2

Hepatic artery angiography shows subtle tumor staining in Segment IVa and no tumor staining in Segment VI (A). A follow-up CT scan taken three weeks later shows lipiodol uptake in the Segment IVa nodule (B).

Fig. 3

By precontrast MRI, the lesion in Segment VI shows low signal on T1-weighted (A) and high signal on T2-weighted MR images (B). Dynamic MRI shows an enhancement of the lesion during the arterial phase (C) and a slightly hyperintensive signal in the liver parenchyma during the portal phase (D). Another 1-cm hypervascular mass, which was not detected in previous imaging studies, was found in the inferior tip of Segment IVb (E).

Fig. 4

Photographs of the laparotomy show a 1-cm reddish brown nodule on the greater omentum (A) and small multiple nodules on the surface of the small bowel (B). A 3-cm hepatic nodule on Segment VI was attached to the liver capsule and shows characteristics similar to other abdominal nodules (C). The pathological examination was positive for splenic tissue (H-E stain, ×100) (D).